| Urban Rehab, Inc | |
|
901 Highway 80 E Clinton MS 39056-5244 | |
| (601) 927-0188 | |
| (601) 292-7998 |
| Full Name | Urban Rehab, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 901 Highway 80 E, Clinton, Mississippi |
| Authorized Official Name and Position | Philip Massey (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6019270188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Urban Rehab, Inc Po Box 2305 Clinton MS 39060-2305 Ph: (601) 927-0188 | Urban Rehab, Inc 901 Highway 80 E Clinton MS 39056-5244 Ph: (601) 927-0188 |
| NPI Number | 1003469743 |
|---|---|
| Provider Enumeration Date | 07/22/2019 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Medicare PECOS PAC ID | 7012214638 |
|---|---|
| Medicare Enrollment ID | O20211230001154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003469743 | NPI | - | NPPES |
| 02551264 | Medicaid | MS | |
| URI-AGENCY | Other | MS | DEPARTMENT OF MENTAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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